[Austrian Syndrome : when Pneumococcus strikes three times]

Austrian syndrome is characterized by the triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae («pneumococcus»). Endocarditis, often occurring in the background, is frequently diagnosed late and requires prompt medical and sometimes surgical management. We report the case of a 51-year-old man admitted for confusion. The initial evaluation revealed bacterial meningitis documented by purulent cerebrospinal fluid, associated with right basal pneumonia. Blood cultures and cerebrospinal fluid cultures identified Streptococcus pneumoniae. The clinical course was marked by hemodynamic deterioration with circulatory shock, multiorgan failure, and cardiac arrhythmias, prompting the performance of transoesophageal echocardiography. This revealed aortic valve endocarditis complicated by a mitro-aortic curtain abscess and severe aortic regurgitation due to valvular perforation. Intensive care management with targeted antibiotic therapy and urgent valve surgery was required. This case illustrates the importance of systematically investigating for endocarditis in any patient with pneumococcal meningitis, particularly when pneumonia is present, to avoid diagnostic delay with potentially fatal consequences.